Ingersoll Knollcrest Os Dental Corporation

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

INGERSOLL KNOLLCREST OS DENTAL CORPORATION

Doing business as

Riverside Oral Surgery

Practice address

316 Knollcrest Dr
Redding, CA 96002-0104

Phone

(919) 656-3004

NPI assigned

Oct 27, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Andrek Jeffrey Ingersoll, DMD

Title

Manager

Phone

(919) 656-3004

Specialties & licenses 1

Addresses

Other names 1

• Riverside Oral Surgery Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603756800000",
    "number": "1215537444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 N TRIUMPH BLVD STE 100",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840435046",
            "telephone_number": "801-494-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 KNOLLCREST DR",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960020104",
            "telephone_number": "919-656-3004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INGERSOLL KNOLLCREST OS DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-27",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A",
        "authorized_official_last_name": "INGERSOLL",
        "authorized_official_first_name": "ANDREK",
        "authorized_official_middle_name": "JEFFREY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "919-656-3004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Oral Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pamela K Ikuta, DO
• Rene Illa
• In Somno Securitas a Professional Nursing Corporation
• Infinite Health
• Laura Ingalls
• Ingersoll Park Marina GP Dental Corporation (Riverbend Family Dental)
• Corinne A Ingram
• Innovative Sleep Centers, Inc.
• Inspire Psychology Services, PC
• Inspired Life Counseling a Marriage and Family Therapy Corporation

• Oral and Maxillofacial Surgery (Dentist) in Redding, CA
• Providers in Redding, CA by specialty
• Oral and Maxillofacial Surgery (Dentist) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.